Provider Demographics
NPI:1992039515
Name:THE CEDAR SANCTUARY,LLC
Entity Type:Organization
Organization Name:THE CEDAR SANCTUARY,LLC
Other - Org Name:DESERT CEDAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-723-7714
Mailing Address - Street 1:610 N ALMA SCHOOL RD
Mailing Address - Street 2:SUITE #24
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3600
Mailing Address - Country:US
Mailing Address - Phone:480-899-9878
Mailing Address - Fax:
Practice Address - Street 1:610 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE #24
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3600
Practice Address - Country:US
Practice Address - Phone:480-899-9878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ444586Medicaid